MEDICARE: DR. SONJA LEIGH BANKS PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY #15920	CA

General Provider Information

NPI Number	:	1891781415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SONJA LEIGH BANKS PHD

Provider Business Mailing Address
First Line	:	9984 SCRIPPS RANCH BLVD # 136
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-1825
Country	:	US
Telephone Number	:	858-212-6060
Fax Number	:

Provider Business Practice Location Address
First Line	:	9820 WILLOW CREEK RD STE 245
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-1116
Country	:	US
Telephone Number	:	858-212-6060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	08/17/2020

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